What?

Germany is the second main European ODA donor after the United Kingdom. According to the DAC, ODA represented 0.42% of its GNI in 2014 and up to 0.52% in 2015 (respectively US $16.56 billion and $17.7 billion in volume). According to our methodology, Germany allocated €956 million and €1.008 billion to global health in 2014 and 2015. Those substantial amounts in volume only represented 0.03% of its GNI in 2014 and 2015, which means that Germany is far from complying with the recommendation of the WHO Commission on Macroeconomics and Health.

The ratio per GNI has been quite stable in the last few years with a peak in 2010 and 2011, even though the overall volumes have increased from €639 million in 2007 to €1,008 million in 2015.

The analysis of the ratio of Development Assistance for Health in relation to the overall ODA shows that, despite an increase of flows in volume, Germany has prioritized global health less and less from 2008 onwards.

How?

The main recipients are global health initiatives such as the Global Fund to Fight AIDS, TB and Malaria and Gavi, the Vaccine Alliance.

Germany is also a large core contributor to the UN agencies such as the World Health Organisation and the UN Population Fund (UNFPA) and to development banks (concessional entities of the World Bank and the African Development Bank).

German DAH is a complex and unique structure: it is composed at the same time of grants, loans and equity investments. We notice an alarming tendency from Germany to increasing loans for the health sector: from €34.8 million in 2007 to €116.4 million in 2015 which represents a 230% increase over 8 years.

Moreover Germany is reporting its equity investments in developing countries –meaning stakes in capital of private companies- as bilateral ODA. Germany has not been holding equity investments on a yearly-basis, they are sporadic and irregular time-wise and quantity-wise. The largest amount invested was €32.4 million in 2013, 2% of the total DAH.

It raises questions on the increase of the countries’ debts but also on the privatisation of health. This shows a tendency to support for-profit companies’ activities in developing countries healthcare industries.

In 2014, all equity investments were carried out in firms on the American continent, but in 2015, on the African continent. We do not have more precise information.

Germany also presents a tendency to tie its aid contrary to the OECD recommendation. In the health sector, 10% of aid was tied in 2014 and 5% in 2015.

To Whom?

China was the main recipient of German DAH in 2014 and 2015, mainly through loans. Afghanistan and Bangladesh were the first recipients of bilateral grants respectively in 2014 and 2015.

TOTAL 2014

GRANTS 2014

LOANS 2014

TOTAL 2015

GRANTS 2015

LOANS 2015

Since the CRS database does not allow providing multiple recipients for one activity, all the multi-countries or multi-regions projects are reported as “unspecified”.

Therefore, only 68% of the total bilateral DAH could be allocable to specific countries in 2014 and 70% in 2015. The situation is even worse when we come to disaggregate DAH by income. In 2014, 28.6% of the amount were unspecified and 24.7% in 2015.

Germany has been allocating a relatively large share of its DAH to upper-middle-income countries, compared to the UK: 14.1% in 2014 and 16.8% in 2015. Thus low-income countries have received 37.2% of total bilateral DAH in 2014 and 32.2% in 2015.

Except from China, which is upper-middle-income, Germany is entirely granting loans to lower-middle income economies.

Germany is essentially channelling its DAH through the public sector: 71.6% in 2014 and 69.7% in 2015 of total DAH were supporting the public system of the recipient countries. As a consequence, Germany is financing civil society and non-governmental organisations less than other donors. This financing to CSOs is mainly funding organisations in Sub-Saharan Africa (up to 69% in 2015).

Unlike other donors such as the UK or the EU institutions, Germany is not financing public-private partnerships in recipient countries.

What for?

Our methodology is proposing an alternative classification to the CRS purpose codes. We’ve tried to classify the health projects according to the SDGs as an attempt to suggest different codes than those proposed by the Working Party on Development Finance Statistics and to produce more detailed information. As mentioned in the methodology, this report is made for food for thought and to trigger the discussions on improving the accuracy of ODA for health.

The fight against epidemics is the main sector financed by Germany, bilateral and multilateral channels aggregated: in 2014, it received 41% of the total DAH and 37% in 2015. This is a consequence of the contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria as multilateral contributions represented about 70% of the financing.

In terms of loans only, support to health systems is emerging as the main funding pot: it represents around 60%. Equity are likewise exclusively invested in the support and reform of health systems.

It’s worth noting that family planning and antenatal and delivery care represent a relatively important share of bilateral DAH compared to other donors. On the other hand, non-communicable diseases, mental health and neglected tropical diseases are under-funded (less than 3 million each per year in average) which is a common trend among the analysed donors.

2014

2015

Transparency

In this project, we tried to assess to what extent each donor is contributing to Universal Health Coverage (UHC) taking into account the difficulty to formulate an extensive procedure to determine what is UHC and what is not. So far, we could only claim 6% of the projects of Germany for 2014 and 2015 are contributing to UHC, mainly due to a lack of detailed information provided through the CRS.

This is a rather poor performance, but still better than France for instance, of which we could only analyse 1% of the projects (99% of the projects either did not participate to UHC or were impossible to analyse).